3 months post-op chin lipo and submentoplasty, hard lump won't go away. Surgeon stumped. What can I do? (photos)

Question

I wore my compression garment almost 24/7 for the first 3-4 weeks and every night two weeks after. My plastic surgeon has injected kenalog on this lump 5 times now. It gets a bit softer then gets hard again. Some fluid was aspirated one time and only a small amount two times after. I did used to massage it — now it's too hard to massage with my fingers. My surgeon says he doesn't know what's wrong and he's never seen this before. What should I do to get rid of this lump? Revision? More steriod?

Lucian Ion, FRCS · Answer

Thank you for your question and I am sorry two see that you had problems following your surgery.

The most effective immediate approach is to have some imaging and understand what it is that distorts the contours. It can be related to scar tissue build up, fatty tissue build up, fluid collection that may not be easily reached. Ultrasound or MRI imaging can help to understand what is going on. It is also possible to do ultrasound guided aspiration if there is still a fluid collection like a seroma.

The treatment would depend on the findings on imaging

Arnold Almonte, DO · Answer

This is a challenging problem, especially after a fairly routine procedure such as lipo and platysmaplasty. It’s often a combination of organized fluid and scar tissue. An imaging study may be helpful. I would advise to continue to massage daily for now and allow this scar to fully settle and mature, as in 6-9 months, then reevaluate. It’s possible you will need a revision procedure to excise the lump and smoothen your neck. But it will be much smaller by then. Good luck.

Daniel Barrett, MD · Answer

Dear torontoscars,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gerald Wittenberg, MSc, DMD (retired) · Answer

The best approach is to re enter the site and release the tissue contours. The anatomy in the area is well known and the surgeon will know the approach. And avoid wearing the bandage more than 2 days, even if it seems counter intuitive

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